Unconventional oil and gas (UOG) production requires a vast quantity of freshwater while generating substantial volumes of wastewater. Although numerous studies have focused on technology development, other aspects beyond treatment technology, including regulations, economics, system logistics, and public perception, play equally or more important roles collectively in the selection and deployment of UOG wastewater management practices. In this article, we begin with a critical analysis of the motivations that drive UOG wastewater management towards treatment and reuse. Then we examine four main barriers against such a paradigm shift, pertaining to treatment technology, regulatory compliance, economic feasibility, and social acceptance. Despite the need of further improving technology efficiency for UOG wastewater treatment, the lack of established regulatory framework, the uncertainties of economic viability, as well as public resistance, hinder practical implementation of treatment technologies. We highlight the importance of knowledge and collaborative efforts from engineers, regulators, policy makers, economists, and social scientists to address those barriers, and emphasize that future research efforts should be directed at domains well beyond treatment technology. A systems approach and broader collaboration across multiple disciplines is needed to translate technology innovation into solutions that truly improve water sustainability in the context of rising UOG production.